A Health Assessment Form is required as part of the Stage 2 application and is only for students who have been provisionally offered an elective placement.

If an application is successful students will be asked to attend an Occupational Health Appointment on the first day of their placement for immunisation screening.This is in accordance with the Department of Health (DOH) guidance for standard communicable disease screening checks required for all new NHS healthcare workers. The screening checks are outlined below. This ensures that all students are adequately protected to undertake clinical activities, minimising infection risk to both patients and staff.

Information to students

Following the offer of a place for a medical elective placement at the University of Cambridge, we are committed to ensuring equality of opportunity for students with impairments and health conditions. Your answers to this health questionnaire will help to ensure that your placement will not place your health at risk and to determine in terms of medical fitness your suitability to work as a student doctor.

The School will provide all reasonable support to enable students with impairments and health conditions to complete the placement.

As a potential future doctor you have a duty to provide all relevant and accurate information to the University Occupational Health Service where it will be held in confidence. The Clinical School will only be informed of the implications of any health problem or disability for your placement with your consent, including the need for making reasonable adjustments or providing other support.

You will be asked to provide information about your health and functional capabilities, and your immunisation records. You will be required to ask your doctor or practice nurse to complete your immunisation records giving dates of immunisation and copies of relevant tests. The official stamp of the Medical Practice, and the signature of the doctor or nurse will be required on this documentation.

If you declare an impairment or health condition which may require adjustments to assist you in your training or affect your work as a doctor then an Occupational Health Adviser may contact you to assist you further.

We will also review your occupational health records to ensure that you fully meet the NHS immunisation and infection control requirements for all health care workers and you will be required to attend an Occupational Health appointment on commencement of your placement to ensure these requirements are met.

Immunisation information

Hepatitis B

All applicants should be vaccinated using the 0, 1 and 6 months vaccination schedule for hepatitis B vaccine, unless known to be immune through previous vaccination or infection. Please give the dates of vaccination. Response to the vaccine should be checked by an antibody test (anti-HBs) taken six to eight weeks after the third injection. A level of >100 mIU/ml is preferable; however, levels of 10mIU/ml or more are accepted as evidence of satisfactory immunity. Students with anti-HBs levels of 10-100mIU/ml should receive one additional dose of vaccine, with no need for further serology. An antibody level below 10mIU/ml is classified as a non-response to vaccine; testing for markers of current or past infection is recommended prior to a repeat course of vaccine. Students who following a repeat course of vaccination, still have anti-HBs below 10mIU/ml, and who have no markers of current or past infection, will require HBIG for protection if exposed to the virus – this process will be fully explained by Occupational Health when you commence your placement at Cambridge.

Please record the date, result and attach a copy of the laboratory test if a blood test has been performed.

Rubella

All applicants should have a documented history of two doses of MMR vaccine or serological evidence of rubella immunity. Please record the date, result and attach a copy of the laboratory test if a blood test has been performed. A past history of the illness alone is not sufficient evidence of immunity.

Measles

All applicants should have a documented history of two doses of MMR vaccine or serological evidence of measles immunity. Please record the date, result and attach a copy of the laboratory test if a blood test has been performed. A past history of the illness alone is not sufficient evidence of immunity.

Tuberculosis (TB)

Applicants should have documentary evidence of tuberculin skin testing or interferon-gamma testing and / or BCG vaccination history. If tuberculin skin test or interferon-gamma tested then the result must be within the last five years. Students from countries of high incidence of TB or who have had contact with patients in settings with high TB prevalence will require an interferon-gamma test, which will be fully explained and with consent performed by occupational health on commencement of your placement.

Varicella Zoster (VZV) – Chickenpox

A history of infection with chickenpox or herpes zoster is adequate evidence of immunity if the applicant has lived in temperate climates during their childhood1. If raised in tropical climates2, despite a history of chickenpox, VZV serological evidence is required. We will offer vaccination to seronegative applicants once they commence their medical training.

In accordance with UK national guidance additional screening tests i.e., for blood borne viruses may be undertaken by Occupational Health on commencement of the elective placement.

1 Temperate regions are defined as United Kingdom, rest of Europe, North America, Antipodes, Middle East and Indian sub-continent

2 Tropical regions are defined as sub-Saharan Africa, South East Asia, Caribbean and Central America

Data Protection Information

This questionnaire forms part of your Occupational Health (OH) record.

Records are held securely, in confidence, by the University’s Occupational Health Service (OHS) in accordance with the Data Protection Act 1998

No identifiable medical or other information you provide in confidence and contained in your OH record will be released to anyone else without your consent being obtained but an opinion about your fitness for clinical study will be given to the Elective Co-ordinator.